When you go online and read about a Rhinoplasty or a Septoplasty, have you ever noticed that people often complain about two related things, nasal packing and splints? In my experience, it’s one of the most common things that well informed people ask me, “Do you use nasal packing or splints after surgery?” Also, people who had Rhinoplasty surgery typically complain about the packing or splints being the most painful part of the surgery.
So what is a nasal pack and splint? A nasal pack is simply a dressing you literally stuff in the nose to absorb any blood. In my experience, there is limited bleeding during the procedure and very rarely do people bleed after a surgery. A septal splint on the other hand, is a hard piece of plastic that you stich on each side of the septum (the middle part separating the left and right of the nasal cavity). This holds the septum in place and puts pressure on it.
So, why use these? This is a question I asked last year along with a medical student working with me. Traditionally, nasal packing and/or splints after these surgeries is used to prevent what is called “a septal hematoma” and keep the septum straight. Like a lot of things in surgery, their use is passed down from generation to generation via training. I do my best to ask, why? Is this just tradition or do we really need this painful part of the procedure.
Dr Quinn and I then conducted a systematic review, which is a large review looking at all the studies ever published on the topic. The results showed that using these splints or packs resulted in more pain without any change in complications.
Currently, here at the Facial Surgery and Cosmetic Center of Ottawa (http://ottawafacialsurgery.com/) I never use nasal packs for Rhinoplasty surgery and rarely do I use nasal splints. The only time I would use nasal splints if there is trauma or excessive tearing of the tissue inside on the septum during the surgery.
I believe that us surgeons should continue asking questions like this so we always do what is right for our patients and not rely on tradition
Dr. James P. Bonaparte M.D., MSc., F.R.C.S. (C)